Individual
DR. JASON M LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1540 SOUTH LAKE ST, FOREST LAKE, MN 55025-2628
(651) 464-7100
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
51178
MN
Other
Enumeration date
08/04/2006
Last updated
11/10/2020
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